The most common type of polypoid nodule is the so-called fibrous or
fibroepithelial polyp, which can form anywhere on the cheek or tongue.
Those associated with the gingival margins are sometimes called fibrous epulis.
The aetiology is not known, but some may be related to chronic trauma from teeth
or dentures.
Macroscopically they are usually smooth-surfaced and pale pink. Each nodule is
composed of
a densely compacted fibrocollagenous core covered by slightly thickened squamous
epithelium.
Although clinically similar to fibrous epulis, giant-cell epulis is often darker
red in
colour and occurs in the gingiva, being attached to the periodontal ligament. It
is composed
of large multinucleate giant cells in a fibrous stroma and is covered by
squamous epithelium.

Pyogenic granulomas, which are histologically and macroscopically similar to
those seen
in the skin, are sometimes seen in the mouth, particularly in pregnancy
(sometimes called '
pregnancy epulis').

Granular cell tumour (formerly called 'granular cell myoblastoma', but now
thought to be
of nerve sheath origin) is a rare tumour occasionally seen in the tongue. It
usually presents
as a raised, domed nodule or an even more raised polyp. Although completely
benign, it will
re-grow if incompletely excised.

White patches in the mouth are an important physical sign

Many conditions produce white thickening of the mucosa in the mouth, including
lichen planus,
Candida infection, and chronic friction from teeth or dentures (frictional
keratosis)
In most cases the cause is not apparent, but it is mainly seen in smokers,
particularly pipe smokers. It is important as a physical sign as this is one way
in which
pre-malignant epithelial dysplasia may present.

The squamous epithelium is thickened and irregular, and there is an overlying
thick horny
layer of keratin.

The most frequent tumours in the mouth are squamous cell carcinomas derived from
the lining epithelium

True benign squamous tumours of the mouth are very rare; most of the lesions
that have the
appearance of benign squamous 'papilloma' are either viral warts or localized
areas of
thickened hyperkeratotic squamous epithelium secondary to chronic trauma.
Invasive squamous
carcinoma is the most important and common lesion.
Established invasive squamous carcinomas present as raised, nodular lesions,
which develop
central ulceration with a hard, raised edge. Tumours on the lip and tongue
are usually recognized at an early stage and are amenable to surgery. Squamous
carcinomas
in the floor of the mouth may be asymptomatic, remaining so until local
invasion is extensive, and surgical removal difficult. Lesions in the cheek may
also present
late, mainly because patients ignore them, ascribing their development to
denture trauma.

Squamous carcinomas of the mouth may arise in areas of epithelial dysplasia

Non-invasive epithelial dysplasia may precede the development of invasive
squamous carcinoma.
Clinically, such areas may present as thick, white patches that are raised above
the level of
surrounding mucosa, or as areas of red, velvety epithelium that are level with
surrounding mucosa.
Such areas require biopsy to establish the presence of epithelial atypia and to
exclude the
development of early invasive tumour.

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